Sister-to-Sister: A New Approach to AIDS in Africa

Although both women and men are dying of AIDS at ever increasing rates in Sub-Saharan Africa, it is women who bear the brunt of the epidemic’s destructive impact. Not only do they account for close to 60 percent of H.I.V.-AIDS infections there, they also suffer disproportionately from the stigmatization that accompanies the disease. And it is women, too, who generally bear the burden of caring for family members who are stricken, as well as orphaned children left behind by their dead parents.

In an effort to address the epidemic’s impact and to seek for solutions, a group of religious women from the United States and a number of countries in Africa have come together to examine possibilities for effecting needed change. The initial result has been the creation of the All Africa Conference: Sister to Sister. A pilot meeting is scheduled to take place on Aug. 12-18 in Nairobi, Kenya, with 100 African religious women attending. The coordinators on the U.S. side are two Sisters of Mercy, Eileen Hogan and Margaret Farley.

How did the idea first arise? One of the two sisters, Margaret Farley—a theologian and ethicist at Yale University—said in a telephone interview from New Haven that it arose in the context of a White House summit on AIDS late in 2000. “Religious leaders, primarily from the countries of the South, had come together to discuss the issues relating to AIDS,” she said. “But few women were present, and although much was said about caring for the sick and the need for compassion, there was silence on three areas: sexuality, the status of women and how these interconnect with poverty and consequently with the impact of AIDS.”

Others sensed the same omission, and as a result, following the White House gathering, Sister Farley—in partnership with U.S.A.I.D.—organized what she described as an interfaith consultation at Yale that included two dozen African women theologians. The hope was that new approaches to AIDS might be viewed through the perspective of African religious women. Silence and gender discrimination, it was felt, had created barriers against considering the issue of prevention: prevention methods now widely used in Western countries tend to be seen in Africa as unacceptable because of cultural and religious factors.

Both Sister Farley and Sister Hogan traveled to Nairobi last February to meet with religious women there to help with the planning of the conference in August. Sister Hogan has long had direct familiarity with the devastation caused by AIDS through her previous ministry as a chaplain at the Women’s House of Detention in New York City. “We met with 15 African religious women from eight countries in Sub-Saharan Africa,” she said in another interview. “Some were sent by their congregations and others by the various ‘sisterhoods’ that exist in African nations.”

During their stay in February, she and Sister Farley heard the African sisters speak of the struggles they were experiencing not just because of issues of silence, gender discrimination and sexual abuse—but also grief. “Many of their blood brothers and sisters and other family members have AIDS, and a number of them have died,” Sister Hogan observed. She went on to note that in addition to grief, “these religious women from Sub-Saharan countries feel a painful restlessness at being unable to help their sick loved ones.” They have no money with which to defray the costs of care, nor do they have the freedom to assist caregivers themselves, she noted. A common refrain among them all was consequently the question: where is God in all this?

As an example of the kind of behavior that has led to the rapid spread of AIDS and the vulnerability of poor women, Sister Hogan told of long-distance truck drivers, away from home for lengthy periods, who stop along their routes in villages where they pay for sexual encounters. “The women are so poor that they have no other way of earning what they—and their children—need just to survive from one day to the next.” Because of avenues of rapid transmission like this, she said, “we haven’t begun to see the full extent of AIDS among women in Africa.”

Sister Farley, too, commented on the connection between AIDS and poverty, and how poverty affects the status of women in Africa. Illiteracy rates remain high for African women because of deeply rooted gender discrimination. “If parents have the means to send only some of their children to school,” she said, “they send the boys, not the girls.” As they move out of childhood, with no education and therefore no skills with which to earn a livelihood, many girls and young women feel driven to accept the paid-for advances of men. Both Sister Farley and Sister Hogan emphasized that a further deadly corollary of poverty is the lack of access to nourishing food. For those infected, the progress of H.I.V. is rapid and, as Sister Hogan bluntly put it, “people without adequate nourishment die quicker.”

For her part, Sister Farley noted that African religious women, though powerful in themselves, have been limited by the lack of resources that might allow them to come together to empower one another in response to the AIDS pandemic. The forthcoming conference, it is hoped, will be a move toward their contributing to that much needed response. Whatever the specifics of the response, it will surely include working to overcome gender-based discrimination. And connected with this discrimination is a patriarchal tradition that keeps many women locked into situations of voicelessness—a voicelessness that manifests itself in widespread reluctance to discuss the pandemic openly. “We found that the word AIDS itself is avoided, and those ill from the disease are simply referred to as ‘being sick,’” Sister Hogan said. When the effects of the disease can no longer be hidden, she added, people who have fallen ill may then be stigmatized and blamed, sometimes even by their own family members. Such blame can be especially painful for a wife whose own husband has infected her.

As for the anti-retroviral drugs available to most H.I.V.-positive people in wealthier parts of the world—drugs that greatly extend life expectancy—only a tiny number in sub-Saharan Africa have access to them. Sister Farley spoke of visiting two AIDS hospices in Ethiopia. “At one,” she said, “they could offer only a few vitamins, and at the other all they had on hand was a watered-down form of aspirin.” Even the use of the relatively inexpensive AZT presents problems. Administered routinely to H.I.V.-positive pregnant women in the United States to prevent mother-child transmission, in Africa its usefulness is limited not only because of cost, but also because even if the child is born without the virus, the mother has no alternative but to nurse her child and risk transmitting the infection to her newborn infant. Few mothers can afford infant formula, and for the ones who can, mixing powdered formula with water that is not clean can lead to other life-threatening illnesses.

The August pilot conference is only a beginning. Two more are also being planned. It is hoped that they will lead to further and wider networking among religious women in Africa that may, in time, promote the kinds of systemic change that could help lower the rate of infection in countries where it is highest. Sister Farley cited Uganda as a country whose political leadership has addressed the question of prevention in a forthright manner, with encouraging results. Now, as the Sister-to-Sister initiative gets under way, their efforts may help create positive changes for women in sub-Saharan Africa. Currently, it is they who carry a disproportionate share of the pandemic’s burdens.